Wiki Hospital admission in post op period due to infection

[damato75]

Can you bill the E/M in the post-op period for an admission to the hospital due to a post-operative cellulitis due to noncompliance? We have a patient who is status post ORIF ankle who did not keep his initial post-operative visit, and allowed his wound to get and stay wet causing the severe cellulitis. He was admitted for IV antibiotics. Is this billable and do I use the 24? Seems inappropriate when it is not really "unrelated".

 

[FTessaBartels]

24 modifier

We would use the -24 modifier in a case like this because this is not considered routine postoperative care.

However, Medicare (and some commercial carriers who are now following Medicare's lead) will not pay for any E/M service in the postoperative period - only for procedureing requiring a return to the OR.

Hope that helps.

F Tessa Bartels, CPC, CEMC

 

[aguelfi]

In this situation I would try it w/ a 24. I would make sure the documentation is specific that this is becasuse of the pt's noncompliance.